Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition

Abstract

To study the prevalence of somatoform disorders (SDs) in primary care, a questionnaire including the modified 25-item version of the Symptom Checklist-90 was administered to 191 patients consecutively consulting their family physician. A stratified sample of the patients was interviewed with the Schedules for Clinical Assessment in Neuropsychiatry. The study showed that 22.3% (confidence interval [CI]: 95%: 16.4-28.1) of the patients fulfilled the diagnostic criteria for an International Classification of Diseases--10th Revision (ICD-10) SD, excluding SD, unspecified, and 57.5% (CI: 95%: 50.5-64.5) for DSM-IV SD. But 30.3% met the criteria (CI: 95%: 23.8-36.9) when the DSM-IV Not Otherwise Specified (NOS) diagnostic group is excluded. The most frequent ICD-10 diagnosis was autonomous dysfunction, for which 14.1% of the patients fulfilled the criteria, whereas the prevalence of the other somatoform diagnosis was between 3.0% and 8.1%. The most frequent DSM-IV diagnoses were SD NOS and undifferentiated SD, which 29.93% and 27.3% of the interviewed patients, respectively, received, whereas the prevalence of the other diagnoses was between 1.0% and 8.1%. A high comorbidity between SDs and other mental disorders was found. The general practitioners identified between 50% and 71% of the patients with an ICD-10 SD and between 36% and 48%, according to DSM-IV criteria. Patients with SDs used more nonpsychiatric health care facilities than other patients (P = 0.01).